NSW insurer low back pain model change is dangerous shift to US-style healthcare

Man with low back pain turns away from desk with computer and other paperwork on it to brace his lower back.

NSW insurer low back pain model change is dangerous shift to US-style healthcare

Man with low back pain turns away from desk with computer and other paperwork on it to brace his lower back.

The NSW State Insurance Regulatory Authority (SIRA) is going down the path of ‘Americanising’ healthcare by changing who patients can see for complex and serious low back medical problems.

SIRA has announced the seemingly innocuous removal of the term ‘physiotherapist’ from the clinical care pathway in its Low Back Pain Model of Care, replacing it with ‘physical therapies’ to allow NSW patients to be treated by non-Ahpra regulated and limited scope exercise providers. 

Patients with acute low back pain require clinical attention at the highest level of qualification possessed by the Australian health system, held by physiotherapists. SIRA’s change to the model of care removes such assurance from the pathway for the 18,000 patients with low back pain, by prioritising ‘dollar value’ for the insurer over value for the patient.

The change not only represents a step away from evidence-informed care, that has been trialled and tested with physiotherapists as leaders in this space, but is a clear step towards ‘insurer-managed care’, in a model facetiously positioned as ‘Value Based Health Care’.

National President for the Australian Physiotherapy Association (APA), Scott Willis, has significant concerns that SIRA is overlooking the vast majority of the submissions they received on this matter and ignoring evidence that demonstrates the outcomes delivered when physiotherapists are part of the primary care team.

“Value based health care must improve both outcomes and costs and not be used as an excuse to cut costs. SIRA’s change in terminology is of benefit solely to them, the funder, at the expense of the NSW tax payer,” Mr Willis said.

“SIRA’s discreet change was initially made without consensus or consult from the APA, and without demonstrating their methodology or supporting evidence which is in direct contradiction of evidence-based practice.

“There is no precedent in Australia to support SIRA’s position – which is now allowing referrals to non-Ahpra regulated exercise providers who can only provide uni-modal ‘physical therapy’. Physiotherapists are part of a tried and tested model, one that SIRA is ignoring to save dollars.

Almost 200 physiotherapists provided overwhelming evidence alongside the APA to SIRA’s review late last year, pointing out their change represents what we consider to be an unsafe over-simplification of guideline-based care.

“77 per cent of submissions received by SIRA in response to their public consultation were from physiotherapists and urged against the devaluation of care. What SIRA is doing is neither evidence-based nor safe for patients. Patients with acute low back pain deserve the best care from a taxpayer-funded insurer; not cost-cutting and American-style health where the insurer dictates what treatments you get.

“There are risks to patient care in NSW if patients are referred to practitioners that are not qualified to take on the responsibility of this scope of patient care and are instead provided treatment by a practitioner not held to Ahpra’s regulatory standard,” he said.

The APA is gravely concerned about SIRA’s indifference to the public consultation they received and their lack of consideration for patients in this NSW taxpayer funded scheme. Especially considering that those with transport accident or workplace injury are a complex and diverse patient group requiring more consideration and quality, not less.

We call on SIRA to reverse its decision and ensure NSW accident patients receive the best care available.



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